Evaluation of the changes in the ganglion cell complex and visual prognostic factors after vitreoretinal surgery for idiopathic macular hole

Purpose: To investigate the ganglion cell-inner plexiform layer (GCIPL), ganglion cell complex (GCC) change determined by spectral domain optical coherence tomography (OCT) in cases undergone surgical treatment for idiopathic macular hole (MH), examine the anatomical indices of the hole structure measured by OCT and correlate between best corrected visual acuity (BCVA). Materials and Methods: Preoperative, postoperative month-1 and month-3 data of 25 eyes of 25 patients, who underwent surgery for idiopathic stage 3 and 4 MH, were retrospectively analyzed. Factors whose effects on BCVA were investigated are age, gender, GCIPL, GCC, hole base diameter, minimum linear dimension, hole height, Macular hole index (MHI), Diameter Hole index, Tractional hole index (THI) and ellipsoid zone (EZ) recovery was determined. The GCIPL and GCC changes of the patients after surgery were compared with the values of the age and sex matched healthy control group in addition to the fellow eyes’ measurements. Results: The patient group consisted of 25 subjects, 32% (n=8) of whom were men and 68% (n=17) of whom were women. The mean age of the patients was 63.8 ± 6.7 (years). The average age of the control group was calculated as 61 ± 8.8 (years) which consisted of 10 males (40%) and 15 females (60%). Preoperative mean of BCVA was 0.91±0.29 logMAR. Post-operative month-1 and month-3 mean of BCVA were 0.74±0.30 logMAR and 0.49±0.26 logMAR respectively (p<0.05). The postoperative 3rd month GCIPL and GCC values of the cases showed a significant decrease compared to the preoperative measurements (p<0.05). There was a statistically significant linear correlation between postoperative 3rd month BCVA and GCC inferior and temporal values (r=-0.560; r=-0.585 and p=0.004; p= 0.002, respectively). A significant positive linear association was found between the postoperative month-3 BCVA,logMAR, the minimum linear diameter and base diameter (r=0.478; r=0.419 and p=0.016; p= 0.037, respectively). EZ defect was strongly associated with postoperative month-3 BCVA and changes in visual acuity (p=0.0001, r= 0.711 and p=0.0001, r= 0.690, respectively). The value of MHI≥0.419 could predict good visual prognosis. Conclusions: Preoperative hole geometry could be used to predict surgical prognosis. In the GCIPL and GCC analysis, the inferior and temporal values are associated with the final visual outcome. Visual acuity decreases as the ellipsoid zone loss increases. MHI≥0.419 may be predictive for good visual prognosis.